Marleine Elkhouri
During a morning safety huddle, Unit 6B Manager Marleine Elkhouri (R) listens to a team member’s report alongside colleagues (L to R) Stanley Cho, Emmanuel Tenazas and Mahadai Deosaran. (Photo: UHN)

"How do we stop our patients from falling?"

It's a common question asked by staff on all units across UHN. The team on 6B at the Toronto General Hospital was experiencing at least one fall per month prompting their Nursing Council to look closer at this issue.

After reviewing incident reports to identify trends, and with an awareness of Caring Safely, UHN's patient and workplace safety transformation, the team set out to make falls a priority – and is now closing in on three months since their last one.

"Caring Safely represents everyone's commitment to safety at UHN," says Scott McIntaggart, Executive Lead, TGH and Senior Vice President, UHN. "Our goal is to eliminate preventable harm to both staff and patients and we continue to weave safety into everday activities by engaging everyone at UHN to foster a culture where safety is a deeply embedded core value."

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On average, there are more than 2,000 reported falls at UHN each year, making it the highest reported incident. However, some of these of falls could be prevented through consistent and reliable application of prevention practices.

Falls one of six HACs targeted for improvement at UHN

As such, falls has been identified as one the six Hospital Acquired Conditions – situations that cause harm to patients but are preventable through highly reliable performance of prevention activities.

As falls are complex and multifactorial, it really takes a team approach to reduce and eliminate them. Unit 6B is a great example of a team working collaboratively towards a collective safety goal and what can be achieved as a result.

By working together and embracing Caring Safely strategies, they earlier this month achieved their target of 60 days without a fall on their unit.

"It really is a team effort," says Marleine Elkhouri, Manager of Unit 6B. "Everyone recognizes that they have a role to play in safety and they have the confidence to speak up for safety."

Unit 6B members
Members of Unit 6B at Toronto General Hospital pose in front of their safety huddle board (L to R): Stanley Cho, Emmanuel Tenazas, Alice Silva, Shobha Sawh, Marleine Elkhouri, Gina Bryden , Natalia Evitch, Mahadai Deosaran, Maria Tangan; (Back L to R): Catarina Santos, Robert Mesina, Mabel Cabaron, Carlos Gomes. (Photo: UHN)

The unit visual board and daily safety huddles are used to highlight falls as a focus. On their visual board, the team tracks the number of days since their last fall. They also highlight adherence to the Falls Prevention Bundle by identifying any patients who have not had a MORSE Risk Assessment, a tool used to assess the falls risk in hospitalized patients, within 24 hours as per the UHN policy.

At their daily huddle, staff members on 6B identify how many of their patients are at risk of falling, if all appropriate fall prevention interventions are in place, and if there has been collaboration with Allied Health colleagues to foster an interdisciplinary approach to interventions and fall prevention strategies.

Team uses a variety of Caring Safely tools

The team also identifies any barriers to fall prevention. The visual board and huddles have been a great way to easily share information across the team.

The team on 6B utilizes Safety Behaviours and Error Prevention Tools. Staff members ask clarifying questions at handoffs to ensure they are aware of their patients' falls risks, and what prevention strategies are in place. They use the Question and Confirm concept to determine contributing factors after a fall event, as well as when identifying a change in a fall risk.

This is supported with strong leadership from Marleine, who promotes an environment where staff members are encouraged to speak up for safety.

When a unit is tracking fall incidents as 6B is, it is imperative that staff not be discouraged when falls happen on their units. Their initial target was 30 days which they achieved and celebrated.

At day 32, they experienced a fall on their unit. It was reported, and the team used the opportunity to brainstorm strategies, and began tracking again from zero days.

Reporting incidents is required and encouraged as UHN further develops a positive safety culture. Learnings from these reports help to trend and develop strategies for reducing preventable harm and helps UHN grow towards our goal of becoming a High Reliability Organization.

The staff members on 6B are enthusiastic about their efforts and have now set out a target of 90 days without a fall on their unit. They are to be congratulated on their great work.

"It is motivating to make it visible, talk about it every day and, most important, to celebrate," says Mahadai Deosaran, a nurse on 6B.​

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